DIABETES, OBESITY

AND NUTRITION STRATEGIC CLINICAL NETWORK

In This Issue:

Who Is At Risk For Developing Diabetes?

Webinar for Health Care Providers

Diabetes Patient Survey of Hospital Experience

Choosing Wisely Canada and Diabetes

Have You Heard of UWALK?

Enhanced Recovery After Surgery (ERAS) Learning Collaborative Session 1

DON SCN Launches a New Website

AHS Executive Leadership Program

DON SCN Core Committee Membership

Transformational Roadmap (TRM)

Canadian Obesity Network (CON) - Calgary Chapter

Obesity Refresh Update

Improving Diabetes Care In The Community—Development of a Foot Care Clinical Pathway

Mosaic PCN In Calgary Encourages Physical Activity Through Their Adult Program

Highlights form SCN Connects 2014

Monthly Provincial Provider Webinar Education on Obesity

Research Highlights November 2014

WHO IS AT RISK FOR

DEVELOPING DIABETES? THE CANADIAN DIABETES RISK QUESTIONNAIRE (developed by the Public Health Agency of Canada) helps identify individuals that are at higher risk of having pre-diabetes or type 2 diabetes. The questionnaire is intended for adults aged 40 to 74 years. Pre-diabetes is a condition where a person‘s blood sugar levels are higher than normal, but not high enough to be diagnosed as diabetes. You can have pre-diabetes or undiagnosed type 2 diabetes without having any obvious warning signs or symptoms. Knowing your risk can help you make healthy choices now that will reduce your risk or even prevent you from developing diabetes. To find out if you are at risk; complete the CANRISK screening tool on the Canadian Diabetes Association (CDA) website: http://www.diabetes.ca/take-the-test For more information from the CDA about screening and diagnosis of diabetes: http://guidelines.diabetes.ca/screeninganddiagnosis

Volume 2, Issue 3 November 2014

Webinar For Health Care Providers

Inpatient Diabetes Management Using Basal Bolus Insulin Therapy Date: Thursday, November 27, 2014 Time: 12:00—13:00 Presented By: Isabelle Emery (Patient Advisor DON SCN) and Dr. Karmon Helmle (Endocrinologist Calgary Zone) Approximately 20% of all patients admitted to Alberta hospitals have Diabetes. High blood sugar in hospital contributes to a patient‘s length of stay, and can increase the rates of readmission and death. Basal bolus insulin therapy prevents blood sugar highs and lows from devel-oping, so patient outcomes are better. The webinar is free of charge and pre-registration is not required. For more information on how to attend visit: http://insite.albertahealthservices.ca/7518.asp

November Is Diabetes Awareness Month

Diabetes Patient Survey of Hospital Experience The Diabetes, Obesity and Nutrition Strategic Clinical Network (DON SCN), in conjunction with AHS DIMR Survey and Evaluation team, sent surveys to approximately 2800 patients across the province targeting those discharged from an Alberta hospital in June 2014, with diabetes coded in their chart. The goal of this survey is to gather feedback from individuals living with diabetes related to their recent hospital experience. This information will be used to inform quality improvement projects and priorities for the DON SCN. Results from this survey are currently being collated, and should be available in early December.

Thank you to everyone who completed the survey! For more information about the Patient Survey; please contact the DON SCN at obesitydiabetesnutrition.scn@albertahealthservices.ca.

Choosing Wisely Canada and Diabetes Submitted by Dr. Alun Edwards

Choosing Wisely Canada, a project born from a similar initiative in the US, is designed as a joint venture between clinicians and patients to discuss improving the quality and efficiency of health care. Specialty societies in Canada have come to consensus on a variety of tests, procedures and treatments that contribute little to patient care and are a significant burden on laboratories, diagnostic

imaging departments and health systems. http://www.choosingwiselycanada.org/ In many ways, the principles of Choosing Wisely align closely with those of AHS‘ Strategic Clinical Networks - from the involvement of patients in discussions to the focus on quality and sustainability of health care. Two national societies (Canadian Society of Endocrinology and Metabolism and the College of Family Physicians of Canada) have independently come up with recommendations about the appropriate ordering or use of capillary glucose testing. These recommendations reinforce the most recent (2013) version of the CDA‘s Clinical Practice Guidelines. CSEM: Don’t recommend routine or multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia. http://www.choosingwiselycanada.org/recommendations/canadian-society-of-endocrinology-and-metabolism/ CFPC: Don’t advise non-insulin requiring diabetics to routinely self-monitor blood sugars between office visits. http://www.choosingwiselycanada.org/recommendations/cmas-forum-on-general-and-family-practice-issues-and-college-of-family-physicians-of-canada/ The underlying principle behind these recommendations is that tests should not be performed unless they inform what the self-managing person with diabetes will do or guide the clinicians assisting them in decision making. There are many people with type 2 diabetes who‘s condition varies little from day to day and repeating tests to confirm so is really not necessary. Reducing testing relieves unnecessary discomfort and, in some cases, significant personal financial costs. Given that the number of Albertans with diabetes is over 200,000 (most not using insulin) the money spent on glucose test strips could be staggering. Reducing testing that has little or no impact on health could easily free up revenue to cover other valuable aspects of diabetes care and for innovation. This is very much in keeping with the Canadian Diabetes Association‘s ‗Thinking Ahead to 2016‘ document which noted : ―Health care dollars are limited and competed for by numerous conditions. ―Advocacy needs to identify areas where savings can be made to compensate for priority spending.” All the SCNs are engaged in the CWC process and our efforts will be needed to discuss how to get the recommendations adopted by patients and clinicians and to achieve improvements in the quality of health care. All Network members should consider the challenge to identify other tests or treatments in Diabetes, Obesity and Nutrition that we can put before Choosing Wisely Canada for consideration and the SCN leadership team would be happy to receive, discuss and pass on any suggestions!

Have You Heard of UWALK? Submitted by Nora Johnston

Looking to interact with your patients in a non-traditional way? UWALK.ca is here to help. UWALK is a province wide initiative that aims to increase the physical activity of Albertans. Our website is an excellent resource to help keep people motivated and on track to better health. Developed by the Faculty of Physical Education and Recreation at the University of Alberta and funded by the Government of Alberta, UWALK.ca is a fun, free and interactive way to track daily physical activity! Visit UWALK.ca to: Create a profile: Creating a profile is fast and easy. Have your patients create their own profiles too. UWALK allows

members to set their own goals, as every individual is different. Log activity: Steps can be tracked steps using a pedometer, or automatically synced using a Fitbit or the Moves app. Connect: You can add patients to your profile and monitor their progress by ‗liking‘ and ‗commenting‘ on how much they

are moving to encourage accountability and provide motivation. Challenge: Challenge yourself or your patients to a UWALK challenge. Use one of the predetermined UWALK challenges,

or customize your own challenge directly on the site to suit your patient‘s needs. The UWALK team is here to help in any way we can!

With a little help from UWALK; you and your patients can log your activity and find your stride! To learn more, just visit UWALK.ca or contact info@uwalk.ca.

Enhanced Recovery After Surgery (ERAS) Learning Collaborative Session 1

On October 17, 2014, the ERAS teams from the 6 pilot sites (Peter Lougheed, Foothills Medical Centre, Royal Alexandra Hospital, University of Alberta Hospital, Grey Nuns Community Hospital, and Misericordia Community Hospital) participated in the first session of a newly established ERAS Learning Collaborative to continue to improve site compliance and outcomes, at their individual sites, with the Enhanced Recovery After Surgery elements. Learning Collaborative (LC) brings together sites teams to engage in a structure and process to continue efforts to improve enhanced surgical care. Over the course of a year, the ERAS Learning Collaborative will provide site teams with three learning workshops or sessions (LC 1, LC 2, LC 3) to develop and use an ERAS site specific balanced scorecard based on data, implement a site action plan focused on the six dimensions of quality, share ongoing progress and learnings related to focused actions for improvement, and address barriers and generate creative solutions. The learning sessions are followed by action

periods with activities such as team meetings and small projects occurring at the ERAS sites and within project implementation. Together, the learning sessions and action periods build capacity both provincially and locally to sustain a culture of quali ty improvement. A collaborative approach combining learning sessions with unique reporting tools has demonstrated success in supporting the implementation of clinical initiatives across the province. This approach to innovation and learning collaborative is based on the Institute for Healthcare Improvement‘s Breakthrough Series (see www.ihi.org). The feedback from the ERAS site teams after the first Learning Collaborative session has been very positive in helping them focus on specific areas for improvement. Plans are being made for the ERAS Learning Collaborative session 2 in February 2015, where the sites will be able to come together again to share their progress and participate in topic specific education sessions.

ERAS Learning Collaborative Session 1 was held in Edmonton on October 17, 2014.

DON SCN Launches A New Website

Please check out our new website at: http://www.albertahealthservices.ca/7676.asp We hope you will find our website useful, and easy to navigate. We welcome your feedback.

AHS Executive Leadership Program

CONGRATULATIONS to Petra O‘Connell (DON SCN Executive Director), who has been accepted into the AHS Executive Leadership program, along with her colleague, Dennis Cleaver (Executive Director for the Seniors Health SCN). The program starts this month, and should be an exciting and challenging opportunity for them.

DON SCN Core Committee Membership

The DON SCN welcomes the following new members to our Core Committee: Isabelle Emery, Patient Advisor Dr. Daniel Van Schalkwyk, Family Physician, Physician

Lead, Weight Management, McLeod River PCN Debra Jakubec, Regional Director, AB/NWT CDA Dr. Paddy Quail, Medical Director, Supportive Living, AHS

Calgary Zone For a complete list of the core committee membership; please visit our website. http://www.albertahealthservices.ca/Strategic%20Clinical%20Networks/ahs -scn-odn-core-membership.pdf

Transformational Roadmap

(TRM)

The Diabetes Obesity and Nutrition (DON) Strategic Clinical Network (SCN) is pleased to share with you the DON SCN Transformational Roadmap 2014-2017 outlining the diabetes, obesity and nutrition priorities for Alberta over the n e x t 3 y e a r s ( a v a i l a b l e a t h t t p : / /www.albertahealthservices.ca/7676.asp. Thank-you to our dedicated DON SCN core committee, network members, and the front line providers, researchers, patients and families who participated in the development of this transformational roadmap, and validated the priorities, vision and mission. Your feedback and comments were used to refine and inform what the DON SCN together with others will focus on over the next three years. The Transformational Roadmap represents our commitment to integrating learnings from research and identifying innovative approaches within clinical care. We are committed to working together with front line providers, researchers, patients and families to support better care, use better ways, and build a better healthcare system related to diabetes, obesity and nutrition. We appreciate and acknowledge the patients and families who participate in the network enabling us to focus on improving patient experience, and achieving the best healthcare outcomes within a sustainable healthcare system. If you would like more information on the DON SCN or would like to get involved, please feel free to contact Glenda Moore, DON SCN Manager at email: glenda.moore@albertahealthservices.ca or phone: 403-943-1847. To learn more about the Strategic Clinical Networks, please visit our web pages at www.albertahealthservices.ca/scn.asp.

Canadian Obesity Network (CON) - Calgary Chapter Submitted on behalf of Dr. Shahebina Walji The Canadian Obesity Network (CON) is pleased to announce that they now have a local chapter in Calgary. There are many benefits to joining, and it's free! The Calgary Chapter was formed in August 2014, and already has a number of members from AHS, the Primary Care Networks and the educational institutions. CON is Canada's professional obesity organization for health care providers, researchers, policy makers and obesity stakeholders. CON-YYC is the first local chapter, and the executive team is working hard to plan valuable local networking and educational events. Save the date for the first CON-YYC event! November 20, join us at U of C for an evening of "Speed Chat" networking to get to know each other. This event will be free and open to CON-YYC members. To join the Calgary chapter: (no charge)

1. If you are not yet a member of CON, please visit http://www.obesitynetwork.ca/join. 2. Send an email to conyycchapter@gmail.com.

For more information about the Calgary chapter of CON, please contact: Dr. Shahebina Walji at: s.walji@cwmc.ca or Janet Walmsley at: Janet.Walmsley@albertahealthservices.ca

Obesity Refresh Update Submitted by Carol Ellendt

Planning for the ‗refresh‘ of the provincial obesity strategy has begun. The AHS Obesity Initiative first launched in 2011, is undergoing a review based on program evaluation outcomes, current evidence, local unmet needs, and health system opportunities and priorities. The Obesity Refresh will be informed through broad stakeholder engagement. The plan will also align with key priorities identified in the Diabetes, Obesity and Nutrition SCN Transformational Roadmap and the 2014 Chronic Disease Management Office of the Auditor General Report. A Work Plan and Engagement Strategy are currently being developed. Stakeholder engagement is expected to occur in early 2015, with a draft plan for approval in Spring 2015.

Improving Diabetes Care In The Community—Development of a Diabetic Foot Care Clinical Pathway The Diabetes, Obesity, and Nutrition Strategic Clinical Network (DON SCN) is leading a project to develop a clinical pathway for diabetic foot care in Alberta. There is growing prevalence of diabetes and an increasing number of lower limb amputations being performed across the province. The majority of these amputations are a result of diabetic foot ulcers which are up to 85% preventable. For this reason the DON SCN is developing a clinical pathway with the goal to improve early detection and treatment of diabetic foot problems, thereby reducing the need for amputations and worsening of health status, which is associated with lower quality of life and higher costs. A Provincial Working Group comprised of members from a variety of disciplines and from all Zones is developing tools and resources to support patients and providers to improve early intervention for individuals with diabetes who are at high risk of developing a foot ulcer or have a foot ulcer. A Steering Committee, Co-chaired by Dr. Laurie M. Parsons (Clinical Assistant Professor of Dermatology, U of C) and Petra O‘Connell (DON SCN) has been established to guide the work of the working group.

Mosaic PCN In Calgary Encourages Physical Activity Through Their Active Adult Program

Submitted by Evan Ward, Active Living Coordinator, Calgary Mosaic PCN The Mosaic Active Adults Program at the Genesis Centre (7555 Falconridge Blvd NE) is a free active living program open to all adults who would like to increase their physical activity in a fun and positive environment. This drop in program runs Monday to Friday from 9am to 12 noon and provides individuals with a safe, warm place to exercise and create new relationships with others in the community. The Mosaic Active Adults Program offers a wide range of self-paced activities which are scheduled multiple days per week. An exercise specialist and registered nurse are always on staff to assist clients to exercise safely, as well as provide health screening services such as blood pressure and blood sugar readings. For more information about the program visit www.MosaicPCN.ca.

Highlights From SCN Connects 2014 Submitted by Serena Humphries

In September, researchers, clinicians, decision-makers and patients gathered at the Banff Centre for three days to learn from each other and shine a spotlight on the work of the SCNs in Alberta. The theme for the first day was ―Partnering for Better Health Outcomes‖ and included a Quality and Research Showcase where SCNs were able to share highlights from the many projects underway within the SCNs. The second day focused on ―Integrating Evidence into Strategic Clinical Networks‖ and a talk by Dr. Brent James (Chief Quality Officer, and Executive Director, Institute for Health Care Delivery Research at Intermountain Healthcare, based in Salt Lake City, Utah) provided much inspiration for break-out discussions with participants. Dr. James stressed the importance of measurement for quality improvement and emphasized that everyone can improve. The conference concluded with a session on ―Leading Practices in Alberta‘s SCNs‖, which included a panel discussion exploring how networks can assess their impact on health outcomes and a patient led panel on engaging Albertans through story. Patient participation throughout the conference was fantastic with the patient voice strongly represented by wonderful patient advocates and patient-engagement researchers who bravely shared their stories and the incredible efforts they have been contributing to the work of the SCNs throughout the province.

Research Highlights November 2014

Dr. Jeffrey Johnson, DON SCN Scientific Director Dr. Serena Humphries, DON SCN Assistant Scientific Director The Office of the Scientific Director for the DON SCN is pleased to provide an update on research and surveillance activities. As part of our commitment to ongoing surveillance of relevant indicators we have been working hard on surveillance activities and have been preparing monthly Fact Sheets on Diabetes, Obesity and Nutrition topics. The data reported in the Fact Sheets is intended to inform planning, implementation and evaluation of health care needs and services provided across the province. You can find all of the DON SCN Fact Sheets posted in the ―Research‖ section of the DON SCN Website (http://www.albertahealthservices.ca/7676.asp). We would like to congratulate several research teams from the DON SCN Research Community on their successful applications for diabetes-focused research grants from the Lawson Foundation. Congratulations to the following Principal Investigators and their teams: Dr. Dean Eurich - RADAR – Reorganizing the Approach to

Diabetes through the Application of Registries Dr. Steve Johnson - Healthy Eating and Active Living for

Diabetes – Gestational Diabetes Mellitus (HEALD-GDM) Dr. Danièle Pacaud - Technology Enhanced Coordinator for

Transition of Care for youth with Diabetes Dr. Ronald Sigal - Evaluation of an Improved Home-based

Alternative to Traditional Weight Training in People with Type 2 Diabetes

We are also very excited to report on an exciting patient engagement project called the Alberta Gestational Diabetes Priority Setting Partnership. Typically, topic areas funded for research are determined by researchers, funding agencies and

governments, with little input from patients or clinicians. The United Kingdom recognized this gap and created the James Lind Alliance (JLA) in 2004 in order to provide a voice for patients and clinicians in the research prioritization process. Over the last 10 years, the JLA has developed and applied a protocol for engaging patients, their caregivers and clinicians in a fair, transparent process, which ensures that patients are not overwhelmed or marginalized. The JLA priority setting partnership (PSP) has been used by many groups for determining patient, caregiver and clinician research priorities. The Alliance for Canadian Health Outcomes Research in Diabetes (ACHORD) and the Diabetes, Obesity, and Nutrition Strategic Clinical Network (DON SCN) are implementing the JLA PSP protocol in Alberta with gestational diabetes patients, their caregivers and clinicians. The objective of the project is to undertake the 4 steps of the JLA PSP process and determine research priorities in the area of gestational diabetes. For more information, or to participate in the survey, please visit the ACHORD website (www.achord.ca).

More Information

If you wish to learn more about our SCN or become more involved, please contact: Glenda Moore (Manager, DON SCN) at glenda.moore@albertahealthservices.ca

Monthly Provincial Provider Webinar Education On Obesity

Supported by the Provincial Bariatric Resource Team

The Provincial Webinar series is an exciting monthly webinar that provides sustainable provincially consistent education on obesity management that is easily accessible across the province. Topics include: Obesity Foundational Knowledge, Prevention, Assessment, Management, Paediatric Obesity, and Clinical Pearls. Link to the webinar series through the CDM Resource Centre Obesity page: http://www.albertahealthservices.ca/7468.asp

Next Session: Date: December 3 Time: 12:00—1:00 Topic: Body Image, Embodiment, and Weight Bias Presenter: Dr. Shelly Russell-Mayhew, R. Psych.